Variability of high-sensitivity cardiac troponin T and I in asymptomatic patients receiving hemodialysis

Variation of high-sensitivity cardiac troponin I and T (hs-cTn) during hemodialysis has been observed. Observational studies demonstrated the increased incidence of adverse cardiovascular events after long compared to short interdialytic intervals. Therefore, we aimed to compare variation of hs-cTnI and hs-cTnT before and after hemodialysis and between short and long interdialytic intervals. We enrolled 200 asymptomatic patients receiving regular hemodialysis. The hs-cTnI and hs-cTnT levels were measured before and after hemodialysis on the day after short and long interdialytic intervals. Mean age was 62.3 ± 14.8 years (Male 55.5%). Prevalence of increased hs-cTnI and hs-cTnT was 34.5% and 99.0%, respectively. The median ± interquartile range of hs-cTnT increased significantly after hemodialysis during short and long interdialytic intervals. However, hs-cTnI level did not increase after hemodialysis during short and long intervals. We found that levels of hs-cTnI and T did not differ between short interdialytic and long interdialytic intervals. We demonstrated higher prevalence of elevated hs-cTnT in patients with regular hemodialysis compared to hs-cTnI. The rise of hs-cTnT was observed immediately after hemodialysis but no significant change of hs-cTnI was noted. Accordingly, hs-cTnI may be preferable as a diagnostic marker in patients with suspected acute myocardial infarction than hs-cTnT.

The association of anemia with high-sensitive cardiac troponin and its influence on the ESC 0/1h and 0/3h algorithms to triage patients with suspected acute myocardial infarction

Introduction According to the 4th Universal Definition of Myocardial Infarction (UDMI), anemia may cause acute and chronic myocardial injury indicated by elevated high-sensitive troponin (hs-cTn) concentrations, with unknown influence on triaging patients with suspected acute myocardial infarction (AMI). Purpose To investigate the influence of anemia on hs-cTnI and the diagnostic performance of the ESC 0/1 and 0/3 hour (h) algorithms. Methods Patients with suspected AMI were prospectively enrolled and stratified based on the hemoglobin (Hb) concentration at admission (females <12 g/dl, males <13g/dl). Hs-cTnI was measured at presentation, 1 and 3h later. Three independent cardiologists adjudicated the final diagnoses according to the 4th UDMI. Patients with ST-elevation AMI were excluded. Our primary endpoints were the safety to rule-out (negative predictive value [NPV]) and the efficacy to rule-in (positive predictive value [PPV]) AMI. Patients were followed for up to 4 years to assess all-cause mortality. Results We included 2,223 patients (64.1% males, age 65 [52; 75]) of whom 415 (18.7%) had anemia. The prevalence of AMI was numerically different for patients with and without anemia (16.4% and 12.9%, p=0.072). Hs-cTnI concentrations were significantly higher in patients with anemia and no AMI (p<0.001 for baseline, 1h and 3h, respectively), but not in patients with AMI (Fig, 1A). Sex- and age-adjusted linear regression modelling in patients without AMI revealed a significant association of Hb with hs-cTnI (Beta −0.10 [95% CI: −0.14, −0.06]; p<0.001; Fig. 1B). Safety and efficacy of both ESC algorithms were similar in patients with and without anemia; 0/1h (NPV 100.0% [95% CI: 94.7, 100.0]; PPV 52.7% [95% CI: 43.0, 62.3] vs. NPV 99.4% [95% CI: 98.5, 99.8]; PPV 55.7% [95% CI: 50.1, 61.1]); 0/3h (NPV 98.0% [95% CI: 95.3, 99.3]; PPV 48.4% [95% CI: 39.4, 57.5] vs. NPV 97.9 [95% CI: 97.0, 98.6], PPV 59.2 [95% CI: 53.7, 64.6]). During a median follow-up of 1.7 years and after stratification by either ESC algorithm, patients with compared to those without anemia experienced significantly worse outcome for all-cause death (p<0.001; Fig. 1C). In sex-, age- and baseline hs-cTnI-adjusted Cox-regression analysis, anemia was an independent predictor for all-cause death (adjusted hazard ratio [adjHR] 3.6 [95% CI: 2.6, 5.0]), cardiovascular death (adjHR 3.0 [95% CI: 1.8, 5.2]) and rehospitalization (adjHR 1.2 [95% CI: 1.0, 1.5], but not for incidental AMI (adjHR 2.0 [95% CI: 0.8, 4.9]) or revascularization (adjHR 0.8 [95% CI: 0.5, 1.3]). Conclusion Despite the revealed association of Hb and hs-cTnI in the stable setting, the application of the ESC 0/1h and 0/3h algorithms in patients with suspected AMI and concomitant anemia is safe and provides similar efficacy. Patients with anemia experience considerable worse outcome and might therefore benefit from additional diagnostic measures and, potentially, treatment targeting anemia and its cause. Figure 1 Funding Acknowledgement Type of funding source: Other. Main funding source(s): German Center of Cardiovascular Research (DZHK) and an unrestricted grant by Abbott Diagnostics, Prevencio and Singulex.

Percepção do enfermeiro frente ao paciente com suspeita de infarto agudo do miocárdio

O estudo teve como objetivo identificar a percepção da enfermeira frente ao atendimento ao paciente com suspeita de Infarto Agudo do Miocárdio (IAM). Trata-se de um estudo qualitativo, descritivo e exploratório, realizado na Unidade de Pronto Atendimento do município de Pedro Leopoldo (MG). Fizeram parte do estudo onze enfermeiros. Emergiram categorias empíricas “A percepção do enfermeiro sobre o reconhecimento do paciente com suspeita de IAM” e “Fatores que interferem na atuação do enfermeiro durante o atendimento ao paciente com suspeita de IAM”. Concluímos que os enfermeiros possuem percepção quanto à importância do reconhecimento precoce dos sinais e sintomas dos pacientes com suspeita de IAM. No entanto, encontram barreiras para realizar esse atendimento. É necessário que se mantenham na busca por capacitação e atualização para continuarem com essa autonomia profissional frente ao paciente com suspeita de IAM, mas espera-se que investimentos sejam feitos pela instituição, visando à melhoria no funcionamento do serviço.Descritores: Infarto Agudo do Miocárdio, Enfermeiro, Assistência. Perception of nurse in front of patient with suspected acute myocardial infarctionAbstract: The study aimed to identify the nurse's perception of the care provided to patients with suspected acute myocardial infarction (AMI). This is a qualitative, descriptive and exploratory study, carried out at the Emergency Care Unit in the city of Pedro Leopoldo (MG). Eleven nurses took part in the study. Empirical categories emerged: “The nurse's perception about the recognition of the patient with suspected AMI” and “Factors that interfere with the nurse's performance during the care of the patient with suspected AMI”. We conclude that nurses are aware of the importance of early recognition of signs and symptoms of patients with suspected AMI. However, they encounter barriers to perform this service. It is necessary to remain in the search for training and updating to continue with this professional autonomy in the face of patients with suspected AMI, but investments are expected to be made by the institution, aiming at improving the service's functioning.Descriptors: Acute Myocardial Infarction, Nurse, Care. Percepción de enfermero delante de pacientes miocardios agudos sospechosoResumen: El estudio tuvo como objetivo identificar la percepción de la enfermera de la atención brindada a los pacientes con sospecha de infarto agudo de miocardio (IAM). Este es un estudio cualitativo, descriptivo y exploratorio, realizado en la Unidad de Atención de Emergencia en la ciudad de Pedro Leopoldo (MG). Once enfermeras participaron en el estudio. Surgieron categorías empíricas: "La percepción de lo enfermero sobre el reconocimiento del paciente con sospecha de IAM" y "Factores que interfieren con el desempeño de la enfermera durante la atención del paciente con sospecha de IAM". Concluimos que los enfermeros son conscientes de la importancia del reconocimiento temprano de los signos y síntomas de pacientes con sospecha de IAM. Sin embargo, encuentran barreras para realizar este servicio. Es necesario permanecer en la búsqueda de capacitación y actualización para continuar con esta autonomía profesional frente a pacientes con sospecha de IAM, pero se espera que la institución realice inversiones, con el objetivo de mejorar el funcionamiento del servicio.Descriptores: Infarto Agudo del Miocardio, Enfermero, Asistencia.

2019 Italian Society of Cardiology Census on telemedicine in cardiovascular disease: a report from the working group on telecardiology and informatics

BackgroundThe aim of this study was to assess by a census supported by the Italian Society of Cardiology (Società Italiana di Cardiologia, SIC) the present implementation of telemedicine in the field of cardiovascular disease in Italy.MethodsA dedicated questionnaire was sent by email to all the members of the SIC: data on telemedicine providers, service provided, reimbursement, funding and organisational solutions were collected and analysed.ResultsReported telemedicine activities were mostly stable and public hospital based, focused on acute cardiovascular disease and prehospital triage of suspected acute myocardial infarction (prehospital ECG, always interpreted by a cardiologist and not automatically reported by computerised algorithms). Private companies delivering telemedicine services in cardiology (ECGs, ambulatory ECG monitoring) were also present. In 16% of cases, ECGs were also delivered through pharmacies or general practitioners. ICD/CRT-D remote control was performed in 42% of cases, heart failure patient remote monitoring in 37% (21% vital parameters monitoring, 32% nurse telephone monitoring). Telemedicine service was public in 74% of cases, paid by the patient in 26%. About half of telemedicine service received no funding, 17% received State and/or European Union funding.ConclusionsSeveral telemedicine activities have been reported for the management of acute and chronic cardiovascular disease in Italy. The whole continuum of cardiovascular disease is covered by telemedicine solutions. A periodic census may be useful to assess the implementation of guidelines recommendations on telemedicine.